脑电偶极子定位手术治疗32例顽固性癫痫临床分析  

Clinical study on surgical treatment for intractable epilepsy using EEG dipole localization method: report of 32 cases

作　　者：王焕明[1] 徐如祥[2] 方冬秀[1] 袁辉胜[1] 

机构地区：[1]湖北省新华医院神经外科,武汉430015 [2]南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2006年第4期410-412,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨脑电偶极子定位法(DLM)在癫痫外科中的临床意义及作用。方法所有患者术前均行脑电DLM定位,并按照术前定出的致痫源偶极子的位置设计手术入路。术中在皮层和深部电极脑电图监测下进行手术,并将DLM与术中脑电图监测结果进行比较。结果经DLM定位后结果显示,致痫灶在颞叶的有12例,额叶11例,枕叶2例,顶叶2例,两个脑叶4例,三个脑叶1 例。术前DLM位置与术中脑电图监测发现的致痫区位置相比,在额、顶、枕叶定位误筹均在10～15 mm 以内,在颞叶癫痫病人中 DLM与术中脑电图监测的发现均完全一致。术后6～24月随访结果显示,21 例患者癫痫控制疗效满意,4例疗效显著,3例效果良好,效果较差3例,术后因并发感染死亡1例。手术总有效率为87．5％(28／32),优良率为78．1％(25／32)。结论 DLM在顽固性癫痫患者术前致痫灶定位方面具有一定的指导意义,它与术中脑电图监测有很高的符合率,且在其指导下行手术患者的疗效满意,说明它是一种可靠的术前无创致痫灶定位方法。Objective To explore the clinical application and significance of EEG dipole localization method （DLM） in surgical treatment for intractable epilepsy. Methods All of the patients were subjected to EEG dipole localization for designing the operative approaches according to the localization results, and then underwent the operations. During the operation, EEG monitoring with cortical and depth electrode recordings was performed and the EEG results were compared with DLM results. Results The DLM examination showed that the epileptogenic lesions were located within the temporal lobe in 12 cases, frontal lobe in l 1, occipital lobe in 2, parietal lobe in 2, two lobes in 4 and three lobes in I. In comparison with intra-operative EEG monitoring results, DLM showed the errors at frontal, parietal and occipital lobes within 10-15 mm, but complete concordance at the temporal lobe. The post-operative follow-up of 6-24 months showed that satisfactory outcome was achieved in 21 cases, significant improvement in 4, good prognosis in 3, poor prognosis in 3 and death in l because of postoperative infection. The total effective rate of epilepsy surgery was 87.5% （28/32）, and excellent rate was 78.1% （25/32）. Conclusion DLM has a good significance in preoperative localization ofepileptogenic lesions of refractory epilepsy cases, which is highly concordant with intra-operative EEG monitoring. Under the guide of DLM, the operations can be successfully performed and the postoperative outcome is satisfactory. All these show that DLM is a reliable non-invasive method of preoperative epileptogenic lesion localization.

关 键 词：脑电偶极子定位法 癫痫外科 

分 类 号：R651[医药卫生—外科学]